Is Male Infertility a Social Blindspot?

Men account for half of all fertility issues among couples, yet the social and scientific spotlight remains fixed on women and their ovaries, writes Jonny Cooper.

Last week, a humble research paper seemed to cut to the very core of the male psyche and its stereotypical make-up.

Popular opinion has it that men are the Duracell bunnies of conception. Unlike women, who are at the behest of their ticking biological clocks from the moment they have their first period, we are supposed to be able to father a child until our dying days. The theory has it that this supreme fertility lends us our reluctance to grow up and accept adult responsibilities: why should we bother to cast aside the hedonism of youth, when the prospect of parenthood can be delayed until a later date?

Well, according to the new research, it may be time to put the champagne – or sperm – on ice.

Scientists at the McGill University in Canada studied women between the ages of 40 and 46 who, between 2010 and 2012, undertook a combined total of 904 IVF cycles. They found that in the couples where the male was 43-and-a-half years old or older, no children were conceived – whereas the women with younger partners went on to have babies. Put simply, men’s fertility appears to decrease with age. We have ticking biological clocks too.

The research was timely. This week is National Fertility Awareness Week in the UK, an occasion that normally heralds a slew of stories about ovaries, with little by comparison focused on their male companions. It’s a situation that speaks of the great divide in the way we approach male and female fertility.

“You just don’t walk into a pub and say ‘alright lads, I’ve got a low sperm count. Fancy a pint?’” says Wannabe Dad, a 35-year-old man who blogs about his struggles with male infertility. “The reality is that there are a good number of blokes who are going through what I’m going through – but no one seems to talk about it because they’re embarrassed. Go on Twitter and you’ll find thousands of women who are openly engaging with infertility issues. For men, the taboo definitely exists.”

To prove his point, Wannabe Dad suggests Googling around the topic of famous people who have spoken about their infertility issues. The results are populated by stories about female celebrities. Nicole Kidman, Sarah Jessica, and Courtney Cox have all had the bravery to speak out about their own stories, while closer to home Kirstie Allsopp has continued to remind women of the difficulty of falling pregnant later in life. In contrast, Gordon Ramsey is the only male of note who has broached the idea of male infertility – he found he had a low sperm count as a result of working in hot kitchen environments – and even then, it was fleetingly.

The suggestion is that men labour under the assumption that they can sire children almost indiscriminately (Wannabe Dad speaks of the pain of hearing others quip that they only have to look at their partner to make them pregnant) and then don’t know how to deal with the issue when it presents itself.

For one leading fertility doctor, this social reticence is evidenced on a daily basis in the patient room. Dr Xiao-Ping Zhai, who is the figurehead behindMake Fertility Conceivable, a national campaign that aims to end the stigma attached to male infertility, says few men visit her clinic of their own volition. “I see some couples who have been trying to conceive for years and the man still hasn’t had a sperm test. It’s a form of denial.”

She thinks our reluctance to tackle male infertility on the social level is reflected in the approach the medical community takes to helping couples conceive. “Around 50pc of fertility issues among couples are contributed by men – yet no one is talking about how we can improve male fertility. Instead, we keep hitting the panic button. As soon as doctors identify a problem with the man’s sperm, they recommend ICSI.”

ICSI – or Intra-Cytoplasmic Sperm Injection – is an invasive procedure that injects a single sperm directly into an egg to fertilise it. Unlike during normal IVF, the fertilisation takes place inside the woman’s body, which means that she has to take a series of drugs to ready her system for the operation. “It’s not fair,” says Dr Zhai. “The man has the problem, but the woman goes through all the medication. And it might not even be necessary. Generally, men are easy to treat.”

According to Dr Zhai, only 10pc of male infertility cases are caused by genetic problems or mechanical blockages. The rest are what she terms “functional” issues – i.e. a malfunctioning sperm reproduction system. We’re talking here about drinking too much, smoking, not getting enough exercise, getting the wrong kind of exercise (cycling in particular can be a sperm killer), or sitting down too long at work. By creating a better environment for the testicles to produce sperm – including the prescription of traditional Chinese medical herbs – Dr Zhai says she can “treat a man within three months”.

It’s not always that easy. Dr Zhai’s alternative methods for alleviating infertility in men and women are not as yet recognised by the wider medical community (she says she is lobbying for clinical studies to ratify her results), so not everyone has ready access. And then there are the 10pc of people who have a genetic or mechanical issue.

“As a child I had an undescended testicle and the theory is that it had an impact on my fertility”, says Wannabe Dad. “Once I got my sperm test back, it was always assumed I would need science. The numbers and quality are so low it would be a miracle to conceive naturally.”

“From that moment on, really, it’s been all-consuming. My wife and I try to laugh about it, try to have a smile and get on with things – but you do have your ups and downs. The worst thing is that you paint a lovely picture of family life, and then you’re told that picture is in major doubt. You have dark moments.

“But I’m proud of how we’ve dealt with this as a couple. We’re there to support each other. My advice to anyone going through this is that it’s no one’s fault. These things happen in life. You just have to talk about it, stick together, and be a team.”